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WASHINGTON -- More than 40 million Americans were living with a substance use disorder in 2020, Capt. Michael King, PhD, MSW, of the Substance Abuse and Mental Health Services Administration (SAMHSA) said Monday.

King was reporting on the results of the SAMHSA annual for 2020. "Many longstanding behavioral health problems are still here and are possibly getting worse," King, who is acting director of SAMHSA's Center for Behavioral Health Statistics and Quality, said on a phone call with reporters. And although the 40 million figure represents a doubling from 2019's estimate of 20 million, King cautioned that "the difference is most likely due to one of the changes in how we conduct our survey and it was a planned change, long in coming -- a change in the diagnostic criteria manual from the DSM-4 to DSM-5. In addition, many of our other methodological changes impacted this number more than likely, so while the number appears much larger, there are many caveats to that."

In terms of mental health, the survey found that 21% of adults -- almost 53 million people -- were classified as having any mental illness, and nearly 6% of the population, or 14 million, had a serious mental illness in the last year, King said. In terms of youth suicide -- the first year the report asked about this issue -- 12% of adolescents had serious thoughts of suicide, 5% had a plan, and 2% attempted suicide in the past year.

SAMHSA continues to make special efforts to include race and ethnicity data in its findings, according to King. "For example, one of the findings that stands out is that among people reporting two or more races, 11%, or just over half a million people, had serious thoughts of suicide, 3% had a suicide plan, and about 1% attempted suicide in the past year," he said, while "among Hispanic or Latino adults, 4%, or nearly 2 million people, had serious thoughts of suicide, 1% had a plan, and about 0.5% had attempted suicide in the past year."

"From a service perspective, our data clearly shows that treatment gaps remain for all of these people," he continued. "Consistent with the prevalence of substance use disorder (SUD), we found that 41 million people were classified as needing substance use treatment, and from a mental health perspective, less than half of the adults with any mental illness -- approximately 46% of them -- actually received any mental health services." And the situation was much worse for those with coexisting SUD and any mental illness: less than 6% of those people actually received services for both, King said.

This survey was the first to ask about vaping; results showed that while most older nicotine users -- approximately 88% -- use only tobacco products like cigarettes, nearly two-thirds of adolescents who were vaping didn't use any other tobacco products, "which shows you what the impact of vaping is," he said.

Other survey findings included:

• In 2020, 21.4% of people ages 12 or older (or 59.3 million people) used illicit drugs in the past year, including 17.9% (or 49.6 million people) who used marijuana. In terms of age, the percentage of people who used marijuana in the past year was highest among young adults ages 18 to 25 (34.5%) compared with 16.3% of those ages 26 or older and 10.1% of adolescents ages 12 to 17.
• Among people ages 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin.
• As far as new substance use was concerned, 1.3 million people in 2020 initiated cigarette smoking, 4.1 million initiated alcohol use, 2.8 million initiated marijuana use, and 1.2 million initiated prescription pain reliever misuse in the past year. The vast majority of people who were past-year initiates of cigarette smoking or alcohol use tried cigarettes or alcohol for the first time before age 26.

The survey is usually based exclusively on data from in-person interviews of 70,000 randomly selected people ages 12 and over; however, due to the pandemic, surveyors were only able to collect data for half of the year -- specifically quarter 1 and quarter 4 -- so the number of interviews for 2020 is only about 35,000. In addition, "we had to add new web survey methods and new content to help assess the impact of the ongoing pandemic," King noted.

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